Adv Ther. 2020 Nov 20. doi: 10.1007/s12325-020-01553-1. Online ahead of print.

Aysegül Aksan ^1 2, Alain Schoepfer ³, Pascal Juillerat ⁴, Stephan Vavricka ⁵, Miguel Bettencourt ⁶, Antonio Ramirez de Arellano ⁷, Simona Gavata ⁸, Neige Morin ⁶, William J Valentine ⁹, Barnaby Hunt ⁹

Author information

• ¹Interdisciplinary Crohn Colitis Centre, Rhein-Main, Frankfurt/Main, Germany.
• ²Justus-Liebig University, Giessen, Germany.
• ³Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Lausanne and University of Lausanne, Lausanne, Switzerland.
• ⁴Gastroenterology, Clinic of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
• ⁵Zentrum für Gastroenterologie und Hepatologie, Zürich, Switzerland.
• ⁶Vifor Pharma Group, Villars-sur-Glâne, Switzerland.
• ⁷Vifor Pharma Group, Glattbrugg, Switzerland. antonio.ramirez@viforpharma.com.
• ⁸Vifor Pharma Group, Glattbrugg, Switzerland.
• ⁹Ossian Health Economics and Communications, Basel, Switzerland.

Abstract

Introduction: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and can result in reduced quality of life and increased healthcare costs. IDA is treated with iron supplementation, either with oral iron therapy (OI) or intravenous iron formulations, including ferric carboxymaltose (FCM), iron isomaltoside 1000 (IIM), and iron sucrose (IS). This analysis compared the cost-effectiveness of FCM versus IIM, IS, and OI in terms of additional cost per additional responder in Switzerland.

Methods: A health economic model was developed to assess the additional cost per additional responder, defined as normalization or an increase of at least 2 g/dL in hemoglobin levels, for FCM versus IIM, IS, and OI. To date, no single head-to-head trial comparing all therapies is available, and therefore relative efficacy data were taken from a published network meta-analysis. Costs of treatment were calculated in 2020 Swiss francs (CHF) using a microcosting approach, and included the costs of iron, healthcare professional time, and consumables. Costs are also presented in euros (EUR) based on an exchange rate of CHF 1 = EUR 0.94.

Results: Response rates with FCM, IIM, IS, and OI were 81%, 74%, 75%, and 69%, respectively, with FCM projected to be the most effective treatment. FCM was associated with cost savings of CHF 24 (EUR 23) versus IIM and of CHF 147 (EUR 138) versus IS, and increased costs by CHF 345 (EUR 324) versus OI. Therefore FCM was considered dominant versus both IIM and IS, improving clinical outcomes with cost savings. FCM was associated with an incremental cost-effectiveness ratio of CHF 2970 (EUR 2792) per additional responder versus OI.

Conclusions: FCM was projected to be the most cost-effective intravenous iron therapy in Switzerland, increasing the number of responders and leading to cost savings for healthcare payers.